The Government Accountability Office (GAO) is investigating the Social Security Administration (SSA)’s use of consultant doctors after it was alleged the doctors had engaged in fraudulent conduct. Specifically, they were conducting disability reviews that were going far faster than was reasonably possible, resulting in both a high rate of denials and large sums of fees being awarded to the consultant doctors by the SSA. This scheme disproportionately harmed low-income disability applicants, who also often lost their insurance when their disability applications were denied.
The SSA requires anyone applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) to undergo a medical review by a Disability Determination Service (DDS) office. Additionally, anyone who is currently receiving SSDI or SSI benefits must periodically have their disability status reviewed, depending on how likely they are to recover from their disability. Typically, the doctors that carry out these reviews will work directly for the DDS and carry out the medical reviews at the DDS offices.
However, due to a large backlog of disability applications, some states have taken to hiring “consultant doctors,” private doctors who conduct disability reviews from their own offices. These consultant doctors would be paid on a case by case basis, meaning the more disability reviews they conducted, the more they would be paid by the SSA. This led some consultant doctors to game the system, rushing through reviews to maximize the amount of money they were paid by the SSA.
Worse still, some doctors were outright discarding disability applications, issuing denials without ever conducting a proper review of the applicants’ disability status. This led to many people being denied disability benefits they otherwise would have been eligible for, if they had undergone an appropriate review by a doctor who wasn’t defrauding the system. For this reason, the GAO is inquiring into the practice of hiring consultants and determining what reforms may need to be implemented to prevent this sort of abuse in the future.
If you or a loved one need assistance applying for SSDI or SSI benefits, it is important that you seek the guidance of an experienced Social Security Disability benefits lawyer. The lawyers at Sullivan & Kehoe, LLP have over 50 years of combined experience between its attorneys and are available to you or your loved one in obtaining Social Security Disability or Supplemental Security Income benefits. To schedule a consultation with our New York Social Security Disability benefits lawyers, call (631) 823-7155.